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Kim Y, Lim M, Kim SY, Kim TU, Lee SJ, Bok SK, Park S, Han Y, Jung HY, Hyun JK. Integrated Machine Learning Approach for the Early Prediction of Pressure Ulcers in Spinal Cord Injury Patients. J Clin Med 2024; 13:990. [PMID: 38398304 PMCID: PMC10889422 DOI: 10.3390/jcm13040990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/19/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024] Open
Abstract
(1) Background: Pressure ulcers (PUs) substantially impact the quality of life of spinal cord injury (SCI) patients and require prompt intervention. This study used machine learning (ML) techniques to develop advanced predictive models for the occurrence of PUs in patients with SCI. (2) Methods: By analyzing the medical records of 539 patients with SCI, we observed a 35% incidence of PUs during hospitalization. Our analysis included 139 variables, including baseline characteristics, neurological status (International Standards for Neurological Classification of Spinal Cord Injury [ISNCSCI]), functional ability (Korean version of the Modified Barthel Index [K-MBI] and Functional Independence Measure [FIM]), and laboratory data. We used a variety of ML methods-a graph neural network (GNN), a deep neural network (DNN), a linear support vector machine (SVM_linear), a support vector machine with radial basis function kernel (SVM_RBF), K-nearest neighbors (KNN), a random forest (RF), and logistic regression (LR)-focusing on an integrative analysis of laboratory, neurological, and functional data. (3) Results: The SVM_linear algorithm using these composite data showed superior predictive ability (area under the receiver operating characteristic curve (AUC) = 0.904, accuracy = 0.944), as demonstrated by a 5-fold cross-validation. The critical discriminators of PU development were identified based on limb functional status and laboratory markers of inflammation. External validation highlighted the challenges of model generalization and provided a direction for future research. (4) Conclusions: Our study highlights the importance of a comprehensive, multidimensional data approach for the effective prediction of PUs in patients with SCI, especially in the acute and subacute phases. The proposed ML models show potential for the early detection and prevention of PUs, thus contributing substantially to improving patient care in clinical settings.
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Affiliation(s)
- Yuna Kim
- Department of Rehabilitation Medicine, College of Medicine, Dankook University, Cheonan 31116, Republic of Korea; (Y.K.); (S.Y.K.); (T.U.K.); (S.J.L.)
| | - Myungeun Lim
- Digital Biomedical Research Division, Electronics and Telecommunications Research Institute, Daejeon 34129, Republic of Korea; (M.L.); (S.P.); (Y.H.)
| | - Seo Young Kim
- Department of Rehabilitation Medicine, College of Medicine, Dankook University, Cheonan 31116, Republic of Korea; (Y.K.); (S.Y.K.); (T.U.K.); (S.J.L.)
| | - Tae Uk Kim
- Department of Rehabilitation Medicine, College of Medicine, Dankook University, Cheonan 31116, Republic of Korea; (Y.K.); (S.Y.K.); (T.U.K.); (S.J.L.)
| | - Seong Jae Lee
- Department of Rehabilitation Medicine, College of Medicine, Dankook University, Cheonan 31116, Republic of Korea; (Y.K.); (S.Y.K.); (T.U.K.); (S.J.L.)
| | - Soo-Kyung Bok
- Department of Rehabilitation Medicine, College of Medicine, Chungnam National University, Daejeon 35015, Republic of Korea;
| | - Soojun Park
- Digital Biomedical Research Division, Electronics and Telecommunications Research Institute, Daejeon 34129, Republic of Korea; (M.L.); (S.P.); (Y.H.)
| | - Youngwoong Han
- Digital Biomedical Research Division, Electronics and Telecommunications Research Institute, Daejeon 34129, Republic of Korea; (M.L.); (S.P.); (Y.H.)
| | - Ho-Youl Jung
- Digital Biomedical Research Division, Electronics and Telecommunications Research Institute, Daejeon 34129, Republic of Korea; (M.L.); (S.P.); (Y.H.)
| | - Jung Keun Hyun
- Department of Rehabilitation Medicine, College of Medicine, Dankook University, Cheonan 31116, Republic of Korea; (Y.K.); (S.Y.K.); (T.U.K.); (S.J.L.)
- Department of Nanobiomedical Science and BK21 NBM Global Research Center for Regenerative Medicine, Dankook University, Cheonan 31116, Republic of Korea
- Institute of Tissue Regeneration Engineering, Dankook University, Cheonan 31116, Republic of Korea
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Sonenblum SE, Feng C, Sprigle S. The relationship between in-seat movement and pressure ulcers in wheelchair users with SCI/D. J Spinal Cord Med 2024; 47:91-99. [PMID: 36260494 PMCID: PMC10795617 DOI: 10.1080/10790268.2022.2122340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE To identify parameters that are associated with time at pressure, are most related to pressure ulcer outcomes, and that may be used to influence pressure ulcer (PrU) outcomes in future intervention studies. DESIGN Analysis used datasets from cross-sectional and longitudinal observational studies. Wheelchair-usage and in-seat metrics thresholds were optimized to differentiate individuals in PrU or No PrU groups. Logistic regression identified the demographics and in-seat activity metrics that impacted PrU outcomes. SETTING General Community. PARTICIPANTS Fifty individuals with spinal cord injuries and/or disorders (SCI/D) who use a wheelchair as their primary mobility device. 22 subjects were within the first year following injury and 28 had been using a wheelchair for over 2 years. Twenty-one participants reported PrU outcomes. INTERVENTIONS Not applicable. OUTCOME MEASURES Time in chair, pressure relief frequency, weight shift frequency, percentage of seated time that the subject is active (CoP Percent Active), frequency of in-seat movement, unloading event frequency, maximum time between events, and number of transfers. RESULTS Optimal cutoff thresholds for the most significant in-seat movement metrics included: unloading event frequency of 3.1 times per hour (OR 0.353, 95% CI [0.110, 1.137]), maximum time between events of 155.4 min (OR 2.888, 95% CI [0.886, 9.413]), and CoP Percent Active of 2.6% (OR 0.221, 95% CI [0.063, 0.767]). When individuals were more active than these cutoffs, significantly more individuals were in the no pressure ulcer group. In predictive modeling, CoP Percent Active was the in-seat movement metric that significantly predicted PrU outcomes. The model was improved by adding age, occupation, and injury completeness. CONCLUSION Of the 4 significant predictors in the model, only CoP Percent Active was modifiable. Therefore, an opportunity exists to design approaches to modify behavior. However, the results illustrate that the key to preventative movement may be through functional movement as opposed to scheduled, routine pressure reliefs.
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Affiliation(s)
- Sharon Eve Sonenblum
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Chen Feng
- H. Milton Stewart School of Industrial & Systems Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Stephen Sprigle
- Rehabilitation Engineering and Applied Research Lab, Georgia Institute of Technology, Atlanta, Georgia, USA
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Burkhart E, Zurek S, Desmond ME, Aguina K, Cabigon RD, Smith A, Bates-Jensen B. Preventing Community-Acquired Pressure Injuries in Spinal Cord Injury: Online Healthcare Provider Curriculum. Rehabil Nurs 2023; 48:190-199. [PMID: 37784225 DOI: 10.1097/rnj.0000000000000437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE The aim of this study was to develop and pilot an educational curriculum for healthcare providers to better understand community-acquired pressure injury (CAPrI) prevention in veterans living with spinal cord injury (SCI). METHODS The Thomas six-step process model guided curricular development and evaluation. Curriculum development followed six steps: (1) problem identification and general needs assessment from a literature review and qualitative research triangulating provider and veteran perspectives of CAPrI prevention in SCI, (2) target needs assessment using a focus group with 14 experienced practicing interprofessional SCI providers, (3) creation of module goals and objectives with content review from experts ( n = 8), (4) development of curriculum content and educational strategies, (5) implementation of a pilot ( n = 4), and (6) evaluation of satisfaction and curriculum content via survey and focus group. RESULTS A five-module online curriculum was evaluated positively and is available publicly. Modules include (1) CAPrI Prevention Clinical Guidelines for the Provider, (2) CAPrI Prevention from the Veteran Perspective, (3) Building Collaborative Relationships, (4) Accessing Resources, and (5) Team Approach. Pilot participants stated objectives were met; they were satisfied with the module. The participants did recommend some changes. CLINICAL RELEVANCE Understanding CAPrI prevention can inform rehabilitation nursing care. CONCLUSIONS An asynchronous educational curriculum can support nurses in integrating preventive care in community-dwelling veterans living with SCI.
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Affiliation(s)
| | - Stacey Zurek
- Loyola University Medical Center, Maywood, IL, USA
| | - Mary E Desmond
- Center of Innovation for Complex Chronic Healthcare, Department of Veterans Affairs, Edward Hines, Jr. VA Hospital, Hines, IL, USA
| | - Keith Aguina
- Center of Innovation for Complex Chronic Healthcare, Department of Veterans Affairs, Edward Hines, Jr. VA Hospital, Hines, IL, USA
| | - Ralph D Cabigon
- Center of Innovation for Complex Chronic Healthcare, Department of Veterans Affairs, Edward Hines, Jr. VA Hospital, Hines, IL, USA
| | - Autumn Smith
- Center of Innovation for Complex Chronic Healthcare, Department of Veterans Affairs, Edward Hines, Jr. VA Hospital, Hines, IL, USA
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Neuhauser C, Sailer CO, Najmanova K, Baumberger M, Paez-Granados D, Schaefer DJ, Wettstein R, Scheel-Sailer A. Risk constellation of hospital acquired pressure injuries in patients with a spinal cord injury/ disorder - focus on time since spinal cord injury/ disorder and patients' age. Spinal Cord 2023; 61:453-459. [PMID: 37407644 DOI: 10.1038/s41393-023-00910-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 06/20/2023] [Accepted: 06/26/2023] [Indexed: 07/07/2023]
Abstract
STUDY DESIGN Prospective cohort study. OBJECTIVES The aim of this study was to evaluate how time since spinal cord injury/disorder (SCI/D) and patients' age influence risk constellation for hospital acquired pressure injuries (HAPI) in patients with a SCI/D. SETTING Acute care and rehabilitation clinic specialized in SCI/D. METHODS We collected patients' characteristics and 85 risk factors for HAPI development in adults with SCI/D with at least one HAPI during their inpatient stay between August 2018 and December 2019. We analyzed patients' characteristics and HAPI risk factors using descriptive statistics according to time since SCI/D ( < 1 year, 1-15 years, > 15 years) and patients' age (18-35 years, 35-65 years, > 65 years). RESULTS We identified 182 HAPI in 96 patients. Comparing patients with SCI/D < 1 year with the other groups, autonomic dysreflexia (p < 0.001), abnormal body temperature (p = 0.001), hypertensive episode (p = 0.005), and pneumonia (p < 0.001) occurred more frequently; mean hemoglobin (p < 0.001), albumin (p = 0.002) and vitamin D levels (p = 0.013) were significantly lower, and patients with time since SCI/D < 1 year scored fewer points (10-12) on the Braden Scale (p < 0.001). Comparing groups per patients' age, only the SCIPUS score was higher in patients > 65 years compared to the other two groups (p = 0.002). CONCLUSIONS Different risk factor constellation seem to be underlying HAPI development with more differences in patients time since SCI/D than patients' age. Awareness of these differences in risk factor constellation depending on time since SCI/D in these patients might lead to different HAPI prevention strategies. SPONSORSHIP The study team didn't receive any additional sponsorship.
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Affiliation(s)
| | - Clara O Sailer
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Department of Clinical Research, University of Basel, Basel, Switzerland
| | | | | | - Diego Paez-Granados
- SCAI-Lab, Department of Health Science and Technology, ETH Zürich, Zürich, Switzerland
| | - Dirk Johannes Schaefer
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital of Basel, Basel, Switzerland
| | - Reto Wettstein
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital of Basel, Basel, Switzerland
| | - Anke Scheel-Sailer
- Swiss Paraplegic Centre, Nottwil, Switzerland.
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland.
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Cantieni T, da Silva-Kress O, Wolf U. Accuracy of Tissue Oxygen Saturation Measurements of a Textile-Based NIRS Sensor. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1438:83-86. [PMID: 37845444 DOI: 10.1007/978-3-031-42003-0_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Abstract
Pressure injuries (PI) are dangerous tissue lesions that heal very slowly and pose a high risk of serious infections. They are caused by pressure applied to the tissue, which stops blood circulation and therefore induces hypoxia, i.e., low tissue oxygen saturation (StO2). PI cause severe suffering and are expensive to treat. Hence it is essential to prevent them with a device that detects a dangerous situation, e.g., by measuring StO2 using near-infrared spectroscopy (NIRS). For such a device to be wearable without causing PI, it must not introduce pressure points itself. This can be achieved by integrating optical fibers into a textile to transport light to and from the tissue.The aim of this paper is to investigate the accuracy of StO2 measurements using a NIRS device based only on textile-integrated optical fibers.Bundles of fibers were stitched into a textile in such a way that loops of <1 mm diameters were formed at the stitching locations. Detection points (DPs) on the fabric consisted of 8 fibers with 3 loops each. Emission points (EPs) were made from 4 fibers with 3 loops each. All fiber ends of a DP were connected to an avalanche photodiode. One end of each fiber belonging to an EP was connected to an LED (740 nm, 810 nm, or 880 nm; 290, 560, or 610 mW).To verify the accuracy of this textile-based sensor, we placed it on a subject's forearm and compared the derived StO2 during arterial occlusion to the values of a gold-standard NIRS device (ISS Imagent), which was placed on the forearm too.We found that our textile-based sensor repeatedly measured StO2 values over a range of 40% with a deviation of <10% from the reference device.By showing the ability to measure StO2 using textile-integrated optical fibers accurately, we have reached a significant milestone on our way to building a wearable device to monitor tissue health and prevent PI.
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Affiliation(s)
- Tarcisi Cantieni
- Institute of Complementary and Integrative Medicine, University of Bern, Bern, Switzerland.
| | - Oliver da Silva-Kress
- Institute of Complementary and Integrative Medicine, University of Bern, Bern, Switzerland
| | - Ursula Wolf
- Institute of Complementary and Integrative Medicine, University of Bern, Bern, Switzerland
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Cantieni T, da Silva-Kress O, Wolf U. Detectability of low-oxygenated regions in human muscle tissue using near-infrared spectroscopy and phantom models. BIOMEDICAL OPTICS EXPRESS 2022; 13:6182-6195. [PMID: 36589557 PMCID: PMC9774876 DOI: 10.1364/boe.473563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/30/2022] [Accepted: 10/01/2022] [Indexed: 06/17/2023]
Abstract
The present work aims to describe the detectability limits of hypoxic regions in human muscle under moderate thicknesses of adipose tissue to serve as a groundwork for the development of a wearable device to prevent pressure injuries. The optimal source-detector distances, detection limits, and the spatial resolution of hypoxic volumes in the human muscle are calculated using finite element method-based computer simulations conducted on 3-layer tissue models. Silicone phantoms matching the simulation geometries were manufactured, and their measurement results were compared to the simulations. The simulations showed good agreement with the performed experiments. Our results show detectability of hypoxic volumes under adipose tissue thicknesses of up to 1.5 cm. The maximum tissue depth, at which hypoxic volumes could be detected was 2.8 cm. The smallest detectable hypoxic volume in our study was 1.2 cm3. We thus show the detectability of hypoxic volumes in sizes consistent with those of early-stage pressure injury formation and, consequently, the feasibility of a device to prevent pressure injuries.
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Feasibility to Measure Tissue Oxygen Saturation Using Textile-Integrated Polymer Optical Fibers. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1395:347-350. [PMID: 36527660 DOI: 10.1007/978-3-031-14190-4_56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Tissue oxygen saturation (StO2) is a crucial factor in the aetiology of pressure injury (PI), since hypoxia leads to necrotization. Pressure on the tissue occludes blood circulation and reduces the StO2, resulting in hypoxia. PI causes severe suffering, heals slowly and is expensive to treat. Hence it is important to prevent PI by detecting hypoxia, e.g., by near-infrared spectroscopy (NIRS) monitoring of StO2. For this, the NIRS device has to be wearable for a long time and it is crucial that it provokes no pressure itself. An integration of optical fibres into a textile achieves this. The aim was to investigate the feasibility of such a textile NIRS device.Knots and loops were tested as textile light emitters (LEs) or detectors (LDs) on a phantom. The light coupling efficiency of the LEs and LDs was investigated.Results show that knots perform similarly to loops. More loops per fibre increase efficiency both in LEs and in LDs. The best trade-off is at 3 loops. LEs are slightly more efficient than LDs, with an average attenuation from baseline of about -2 dB for loops of 0.5 mm diameter. Adding fibres multiplies the signal by the number of fibres. Inclusions mimicking hypoxia in phantoms were successfully identified. In-vivo arm occlusion tests showed the expected decrease in StO2. This shows feasibility of optical fibres in a textile to prevent PI.
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Najmanova K, Neuhauser C, Krebs J, Baumberger M, Schaefer DJ, Sailer CO, Wettstein R, Scheel-Sailer A. Risk factors for hospital acquired pressure injury in patients with spinal cord injury during first rehabilitation: prospective cohort study. Spinal Cord 2021; 60:45-52. [PMID: 34373592 DOI: 10.1038/s41393-021-00681-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 07/23/2021] [Accepted: 07/23/2021] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Prospective observational cohort study. OBJECTIVES First, describe pressure injury (PI) and associated risk factors in individuals with spinal cord injury/disorder (SCI/D) during first rehabilitation. Second, evaluate a prediction model for hospital acquired PI (HAPI) development. SETTING Acute care and rehabilitation clinic specialized in SCI/D. METHODS Patients ≥18 years of age with SCI/D were included during first rehabilitation between 08/2018 and 12/2019. We performed a systematic literature search to identify risk factors for PI development. Patients were classified according to HAPI developed. Between group differences of patients' characteristics and risk factors were analyzed using descriptive statistics. Logistic predictive models were performed to estimate HAPI development and receiver operator characteristic (ROC) curve was used to test the model. RESULTS In total, 94 patients were included, 48 (51.1%) developed at least one HAPI and in total 93 were observed, mainly stage I and stage II HAPI according to the European Pressure Ulcer Advisory Panel. We found nine significantly associated risk factors: completeness of SCI/D, pneumonia, sedative medications, autonomic dysreflexia, Braden ≤12 points, SCIPUS ≥9 points, lower admission SCIM and lower admission FIM-cognition, longer length of stay (LOS) (p ≤ 0.0005). In a predictive model, none of the risk factors was associated with HAPI development (AUC = 0.5). CONCLUSION HAPIs in patients with SCI/D during first rehabilitation are a frequent and complex condition and associated with several risk factors. No predictive model exists but with the identified risk factors of this study, larger studies can create a tailored and flexible HAPI risk prediction model.
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Affiliation(s)
| | | | - Jörg Krebs
- Swiss Paraplegic Centre, Nottwil, Switzerland
| | | | - Dirk Johannes Schaefer
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital of Basel, Basel, Switzerland
| | - Clara O Sailer
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland.,Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Reto Wettstein
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital of Basel, Basel, Switzerland
| | - Anke Scheel-Sailer
- Swiss Paraplegic Centre, Nottwil, Switzerland. .,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland.
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Burkhart L, Skemp L, Siddiqui S, Bates-Jensen B. Developing a decision support tool to prevent community-acquired pressure injuries in spinal cord injury in ambulatory care: A nurse-led protocol for mix methods research. Nurs Outlook 2021; 69:127-135. [PMID: 33583605 DOI: 10.1016/j.outlook.2021.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 12/13/2020] [Accepted: 01/10/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is a lack of formal guidelines and decision support tools to prevent community-acquired pressure injuries (CAPrIs) in Veterans with spinal cord injury (SCI). PURPOSE In this article we present our research protocol that describes our plans to create and test a decision support tool to prevent CAPrIs in SCI. METHODS In Aim 1, we identified mental-models of CAPrI prevention from the perspectives of Veterans (using photovoice, guided tours), and Veterans Health Administration SCI providers (using interviews), and triangulation to compare the two mental-models. This led to a decision support tool developed and validated using Delphi approaches in Aim 2 and will be followed by tool automation and system redesign for pilot implementation in Aim 3. FINDINGS The nurse-led research protocol provides a map to systematically explore, address and translate research into evidence-based practice. DISCUSSION Refinement of the protocol will guide future research and implementation.
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Affiliation(s)
- Lisa Burkhart
- Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. Hospital, Hines, IL; Marcella Niehoff School of Nursing, Loyola University Chicago, Chicago, IL.
| | - Lisa Skemp
- Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. Hospital, Hines, IL; Marcella Niehoff School of Nursing and Parkinson School of Health Sciences and Public Health, Maywood, IL
| | | | - Barbara Bates-Jensen
- School of Nursing and David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
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Rosin NR, Tabibi RS, Trimbath JD, Henzel MK. A Primary Care Provider's Guide to Prevention and Management of Pressure Injury and Skin Breakdown in People With Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2020; 26:177-185. [PMID: 33192045 DOI: 10.46292/sci2603-177] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Skin breakdown, including burns and pressure injuries (PrIs), is a devastating complication of spinal cord injury (SCI). Chronic wounds place the person with SCI at high risk of infections, sepsis, and death. Skin health and breakdown is individual and multifactorial, thus prevention requires individualized education focused on patient preferences and goals. Assessment requires an accurate description of wound type/PrI stage, location, size, wound bed, wound margin, epithelialization, exudate, and peri-wound condition. PrIs should be staged using the National Pressure Injury Advisory Panel (NPIAP) staging system. Successful treatment requires optimal wound bed preparation, pressure off-loading, and access to surgical specialists if needed. Mattress and seating systems, pressure relief, skin microclimate, nutrition, and home supports should be optimized. To promote wound healing and aid prevention, identifiable causes need to be removed, risk factors improved, and wound care provided. Infection should be treated with input from infectious disease specialists. Consideration for specialized surgical management including flaps and primary closures should be coordinated with the interdisciplinary team to optimize outcomes. If comorbid conditions promote wound chronicity, a palliative rather than curative treatment plan may be needed.
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Affiliation(s)
- Nicole R Rosin
- Spinal Cord Injury Primary Care, Clement J. Zablocki VA Medical Center, Milwaukee, Wisconsin
| | | | | | - Mary Kristina Henzel
- Spinal Cord Injuries and Disorders Center, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio.,Case Western Reserve University/MetroHealth System, Department of Physical Medicine & Rehabilitation, Cleveland, Ohio
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Development of the spinal cord injury pressure sore onset risk screening (SCI-PreSORS) instrument: a pressure injury risk decision tree for spinal cord injury rehabilitation. Spinal Cord 2020; 59:123-131. [PMID: 32694750 DOI: 10.1038/s41393-020-0510-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 06/18/2020] [Accepted: 06/19/2020] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Psychometric study based on retrospectively collected data. OBJECTIVE Development of a pressure injury (PI) risk screening instrument for use during spinal cord injury (SCI) rehabilitation. SETTING Tertiary rehabilitation center. METHODS Medical charts of 807 inpatients participating in SCI rehabilitation were reviewed. Two models (recursive partitioning and logistic regression) were developed with demographic and Functional Independence Measure (FIM) variables and compared with the SCI Pressure Ulcer Scale (SCIPUS, n = 603) and Braden scale (n = 100) using modeling (n = 615) and validation (n = 192) datasets. Sensitivity and specificity analyses were completed for each model. Models yielding high sensitivity and area under the curve (AUC), while minimizing false negatives (FN < 0.5%) were preferred. RESULTS In the modeling dataset, a single dichotomized FIM variable, Bed/Chair Transfers <4, was predictive of PI incidence (sensitivity = 97%, AUC = 74%, FN = 0.49%) and had similar metrics as the logistic regression model (sensitivity = 97%, AUC = 76%, FN = 0.49%). The recursive partitioning model had fewer FN (sensitivity = 98%, AUC = 75%, FN = 0.33%). When applied to the validation dataset, both models performed similarly. The SCIPUS performed poorly (AUC < 70%). When analyses were limited to cases with available Braden data and no admission PI, recursive partitioning outperformed the other methods for PI risk screening. CONCLUSION A recursive partitioning model, named the SCI-PreSORS (SCI Pressure Sore Onset Risk Screening), demonstrated promise for PI risk screening during inpatient SCI rehabilitation. Prospective validation of the new model is warranted.
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Sonenblum SE, Seol D, Sprigle SH, Cathcart JM. Seated buttocks anatomy and its impact on biomechanical risk. J Tissue Viability 2020; 29:69-75. [PMID: 32008891 DOI: 10.1016/j.jtv.2020.01.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 01/13/2020] [Accepted: 01/20/2020] [Indexed: 11/28/2022]
Abstract
AIM The objective of this study was to describe the amount, types, and shapes of tissue present in the buttocks during sitting (i.e., seated buttocks soft tissue anatomy), and the impact of seated buttocks soft tissue anatomy on biomechanical risk. MATERIALS AND METHODS The buttocks of 35 people, including 29 full-time wheelchair users with and without a history of pelvic pressure ulcers were scanned sitting upright on 3" of flat HR45 foam in a FONAR Upright MRI. Multi-planar scans were analyzed to calculate bulk tissue thickness, tissue composition, gluteus maximus coverage at the ischium, the contour of the skin, and pelvic tilt. RESULTS Bulk tissue thickness varied from 5.6 to 32.1 mm, was composed mostly of adipose tissue, and was greatest in the able-bodied cohort. Skin contours varied significantly across status group, with wheelchair users with a history of pressure ulcers having tissue with a peaked contour with a radius of curvature of 65.9 mm that wrapped more closely to the ischium (thickness at the apex = 8.2 mm) as compared to wheelchair users with no pressure ulcer history (radius of curvature = 91.5 mm and apex thickness = 14.5 mm). Finally, the majority of participants presented with little to no gluteus coverage over their ischial tuberosity, regardless of status group. CONCLUSIONS This study provides quantitative evidence that Biomechanical Risk, or the intrinsic characteristic of an individual's soft tissues to deform in response to extrinsic applied forces, is greater in individuals at greater risk for pressure ulcers.
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Affiliation(s)
- Sharon E Sonenblum
- Rehabilitation Engineering and Applied Research Laboratory, The George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, 801 Atlantic Dr. Office 026, Atlanta, Georgia.
| | - Davin Seol
- Rehabilitation Engineering and Applied Research Laboratory, The George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, 801 Atlantic Dr. Office 026, Atlanta, Georgia.
| | - Stephen H Sprigle
- Rehabilitation Engineering and Applied Research Laboratory, College of Design and The George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, 801 Atlantic Dr., Lab 027, Atlanta, Georgia.
| | - John McKay Cathcart
- Lecturer in Diagnostic Radiography, Room 17J10, School of Health Sciences Ulster University, Shore Road, Jordanstown, Newtownabbey, Antrim, Ireland.
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Mervis JS, Phillips TJ. Pressure ulcers: Pathophysiology, epidemiology, risk factors, and presentation. J Am Acad Dermatol 2019; 81:881-890. [DOI: 10.1016/j.jaad.2018.12.069] [Citation(s) in RCA: 97] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 12/14/2018] [Accepted: 12/17/2018] [Indexed: 12/15/2022]
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14
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Donhauser M, Grassner L, Klein B, Voth M, Mach O, Vogel M, Maier D, Schneidmueller D. Severe pressure ulcers requiring surgery impair the functional outcome after acute spinal cord injury. Spinal Cord 2019; 58:70-77. [PMID: 31312018 DOI: 10.1038/s41393-019-0325-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 06/26/2019] [Accepted: 06/26/2019] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Retrospective matched cohort study. OBJECTIVES Assessing the influence of surgically managed grade 3 and 4 pressure ulcers (PU) in the acute phase after spinal cord injury (SCI) on the neurological and functional outcome after 1 year. SETTING Specialized SCI-unit within a level 1 trauma center in Murnau, Germany. METHODS We performed a retrospective matched cohort study. For every patient with acute SCI and a PU requiring surgery, we identified matched controls within our database in a 1:3 ratio. Matching criteria were: AIS-grade (American Spinal Injury Association Impairment Scale), neurological level and age. The scores of the SCIM-III (Spinal Cord Independence Measure) and the ISNCSCI (International Standards for Neurological Classification of Spinal Cord Injury) as well as the total length of stay (LOS) at the hospital were used as outcome parameters. We applied a stratified analysis using a conditional logistic regression to test for group differences in each outcome parameter of the study. RESULTS In a 6-year period (2010-2015) 28 patients required flap surgery due to 3-4° PU in the acute phase after SCI. Of these patients, 15 had complete data sets according to the EMSCI (European Multicenter Study about Spinal Cord Injury) protocol. Patients with severe PUs during the acute SCI phase had a significantly impaired functional outcome. After 1 year the improvement of the SCIM score was significantly lower in the PU group compared to the control group (17.4 versus 30.5; p < 0.006). However, the change in AIS grade after 1 year was not significantly affected. The LOS was prolonged by a mean of 48 days in the PU group (p < 0.006). CONCLUSIONS Severe PUs requiring surgery in the acute phase after SCI impair the functional outcome and increase LOS. Preventive measures should be applied to all acute SCI patients. Patients should be transferred to specialized SCI-centers as soon as possible.
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Affiliation(s)
- Martin Donhauser
- Center for Spinal Cord Injury, Trauma Center Murnau, Murnau am Staffelsee, Germany.
| | - Lukas Grassner
- Center for Spinal Cord Injury, Trauma Center Murnau, Murnau am Staffelsee, Germany.,Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria.,Institute of Molecular Regenerative Medicine, Spinal Cord Injury and Tissue Regenerations Center Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Barbara Klein
- Institute of Molecular Regenerative Medicine, Spinal Cord Injury and Tissue Regenerations Center Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Maika Voth
- Department of Trauma-, Hand- and Reconstructive Surgery, Goethe University Frankfurt, Frankfurt, Germany
| | - Orpheus Mach
- Center for Spinal Cord Injury, Trauma Center Murnau, Murnau am Staffelsee, Germany
| | - Matthias Vogel
- Center for Spinal Cord Injury, Trauma Center Murnau, Murnau am Staffelsee, Germany
| | - Doris Maier
- Center for Spinal Cord Injury, Trauma Center Murnau, Murnau am Staffelsee, Germany
| | - Dorien Schneidmueller
- Department of Trauma-, Hand- and Reconstructive Surgery, Goethe University Frankfurt, Frankfurt, Germany.,Departement of Traumatology, Trauma Center Murnau, Murnau am Staffelsee, Germany
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Gould LJ, Bohn G, Bryant R, Paine T, Couch K, Cowan L, McFarland F, Simman R. Pressure ulcer summit 2018: An interdisciplinary approach to improve our understanding of the risk of pressure‐induced tissue damage. Wound Repair Regen 2019; 27:497-508. [DOI: 10.1111/wrr.12730] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 02/12/2019] [Accepted: 05/07/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Lisa J. Gould
- South Shore Hospital Center for Wound Healing Weymouth Massachusetts
| | | | - Ruth Bryant
- Abbott Northwestern Hospital Minneapolis Minnesota
| | - Tim Paine
- Department of RehabilitationLitchfield Hills Orthopedic Torrington Connecticut
| | - Kara Couch
- Wound Healing and Limb Preservation CenterGeorge Washington University Hospital Washington District of Columbia
| | - Linda Cowan
- Center of Innovation on Disability and Rehabilitation ResearchVirginia Health Care Richmond Virginia
| | | | - Richard Simman
- Jobst Vascular InstituteUniversity of Toledo College of Medicine Toledo Ohio
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Higgins J, Laramée MT, Harrison KR, Delparte JJ, Scovil CY, Flett HM, Burns AS. The Spinal Cord Injury Pressure Ulcer Scale (SCIPUS): an assessment of validity using Rasch analysis. Spinal Cord 2019; 57:874-880. [PMID: 31053776 DOI: 10.1038/s41393-019-0287-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 04/23/2019] [Accepted: 04/24/2019] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Secondary analysis of retrospective data. OBJECTIVE The aim of this study was to further validate the Spinal Cord Injury Pressure Ulcer Scale (SCIPUS) using Rasch analysis. SETTING Two rehabilitation centers in Canada. METHOD Data were collected as part of the Spinal Cord Injury Knowledge Mobilization Network (SCI KMN) initiative. The SCIPUS was completed within 72 h of inpatient admission. Persons admitted for initial rehabilitation in two inpatient spinal cord rehabilitation programs were included in the project. RESULTS Data from 886 participants were analyzed, approximately 60% of whom were males. Rasch analyses demonstrated that the SCIPUS, in its current format did not meet criteria required for true measurement. A transformed version of the SCIPUS obtained by deletion of misfitting items and modification of the response scales improved fit to the model and showed preliminary evidence of unidimensionality. The person separation index, however indicated that the scale requires further adjustments of its scoring options. CONCLUSIONS In its original form, the SCIPUS does not meet the requirements of the Rasch model and its total score should be used cautiously. However, following some adjustments to the items such as addressing DIF between sites to insure a standardized assessment across sites and adding response options to some of the items, interval-scale measurement should be possible.
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Affiliation(s)
- Johanne Higgins
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Canada. .,Institut universitaire sur la réadaptation en déficience physique de Montréal (IURDPM) of the Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Ile-de-Montréal, Montreal, QC, Canada. .,School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada.
| | - Marie-Thérèse Laramée
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Canada.,Institut universitaire sur la réadaptation en déficience physique de Montréal (IURDPM) of the Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Ile-de-Montréal, Montreal, QC, Canada
| | - Kate Rousseau Harrison
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Canada.,Institut universitaire sur la réadaptation en déficience physique de Montréal (IURDPM) of the Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Ile-de-Montréal, Montreal, QC, Canada
| | - Jude J Delparte
- Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada
| | - Carol Y Scovil
- Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Heather M Flett
- Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada.,Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Anthony S Burns
- Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada.,Division of Physiatry, Department of Medicine, University of Toronto, Toronto, ON, Canada
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17
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Flett HM, Delparte JJ, Scovil CY, Higgins J, Laramée MT, Burns AS. Determining Pressure Injury Risk on Admission to Inpatient Spinal Cord Injury Rehabilitation: A Comparison of the FIM, Spinal Cord Injury Pressure Ulcer Scale, and Braden Scale. Arch Phys Med Rehabil 2019; 100:1881-1887. [PMID: 31054293 DOI: 10.1016/j.apmr.2019.04.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 03/27/2019] [Accepted: 04/04/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Assess the utility of the admission Spinal Cord Injury Pressure Ulcer Scale (SCIPUS), Braden Scale, and the FIM for identifying individuals at risk for developing pressure injury during inpatient spinal cord injury (SCI) rehabilitation. DESIGN Retrospective cohort. SETTING Two tertiary rehabilitation centers. PARTICIPANTS Individuals (N=754) participating in inpatient SCI rehabilitation. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Logistic regression analysis was performed to determine the utility of the SCIPUS, Braden Scale, and FIM for identifying individuals at risk for developing pressure injury (PI) during inpatient SCI rehabilitation. Sensitivity, specificity, positive predictive value, negative predictive value, false negative rate, odds ratio, likelihood ratio, and area under the curve (AUC) are reported. RESULTS The SCIPUS total score and its individual items did not demonstrate acceptable accuracy (AUC≥0.7) whereas the Braden Scale (0.73) and the FIM score (0.74) did. Once items were dichotomized into high and low risk categories, 1 Braden item (friction and shear), 5 FIM items (bathing, toileting, bed/chair transfer, tub/shower transfer, toilet transfer), the FIM transfers subscale, FIM Motor subscale, and the FIM instrument as a whole, maintained AUCs ≥0.7 and negative predictive values ≥0.95. The FIM bed/chair transfer score demonstrated the highest likelihood ratio (2.62) and overall was the most promising measure for determining PI risk. CONCLUSION Study findings suggest that a simple measure of mobility, admission FIM bed/chair transfer score of 1 (total assist), can identify at-risk individuals with greater accuracy than both an SCI specific instrument (SCIPUS) and a PI specific instrument (Braden). The FIM bed/chair transfer score can be readily determined at rehabilitation admission with minimal administrative and clinical burden.
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Affiliation(s)
- Heather M Flett
- Brain and Spinal Cord Rehabilitation Program, Lyndhurst Centre, Toronto Rehabilitation Institute, University Health Network, Toronto, ON; Department of Physical Therapy, University of Toronto, Toronto, ON.
| | - Jude J Delparte
- Brain and Spinal Cord Rehabilitation Program, Lyndhurst Centre, Toronto Rehabilitation Institute, University Health Network, Toronto, ON
| | - Carol Y Scovil
- Brain and Spinal Cord Rehabilitation Program, Lyndhurst Centre, Toronto Rehabilitation Institute, University Health Network, Toronto, ON; Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON
| | - Johanne Higgins
- Research Unit, Integrated University Centre for Health and Social Services for South Central Island of Montreal-Institute of Rehabilitation Gingras-Lindsay-de-Montréal, Montreal, QC; School of Rehabilitation Faculty of Medicine, University of Montreal, Montreal, QC; Center for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, QC
| | - Marie-Thérèse Laramée
- Research Unit, Integrated University Centre for Health and Social Services for South Central Island of Montreal-Institute of Rehabilitation Gingras-Lindsay-de-Montréal, Montreal, QC; Center for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, QC; Spinal Cord Injury Program, CCSMTL, - Institute of Rehabilitation Gingras-Lindsay-de-Montréal, Montreal, QC
| | - Anthony S Burns
- Brain and Spinal Cord Rehabilitation Program, Lyndhurst Centre, Toronto Rehabilitation Institute, University Health Network, Toronto, ON; Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, ON, Canada
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18
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Evaluating the development and validation of empirically-derived prognostic models for pressure ulcer risk assessment: A systematic review. Int J Nurs Stud 2019; 89:88-103. [DOI: 10.1016/j.ijnurstu.2018.08.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 08/09/2018] [Accepted: 08/13/2018] [Indexed: 12/12/2022]
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19
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Bogie KM, Zhang GQ, Roggenkamp SK, Zeng N, Seton J, Tao S, Bloostein AL, Sun J. Individualized Clinical Practice Guidelines for Pressure Injury Management: Development of an Integrated Multi-Modal Biomedical Information Resource. JMIR Res Protoc 2018; 7:e10871. [PMID: 30190252 PMCID: PMC6231753 DOI: 10.2196/10871] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 06/22/2018] [Indexed: 11/23/2022] Open
Abstract
Background Pressure ulcers (PU) and deep tissue injuries (DTI), collectively known as pressure injuries are serious complications causing staggering costs and human suffering with over 200 reported risk factors from many domains. Primary pressure injury prevention seeks to prevent the first incidence, while secondary PU/DTI prevention aims to decrease chronic recurrence. Clinical practice guidelines (CPG) combine evidence-based practice and expert opinion to aid clinicians in the goal of achieving best practices for primary and secondary prevention. The correction of all risk factors can be both overwhelming and impractical to implement in clinical practice. There is a need to develop practical clinical tools to prioritize the multiple recommendations of CPG, but there is limited guidance on how to prioritize based on individual cases. Bioinformatics platforms enable data management to support clinical decision support and user-interface development for complex clinical challenges such as pressure injury prevention care planning. Objective The central hypothesis of the study is that the individual’s risk factor profile can provide the basis for adaptive, personalized care planning for PU prevention based on CPG prioritization. The study objective is to develop the Spinal Cord Injury Pressure Ulcer and Deep Tissue Injury (SCIPUD+) Resource to support personalized care planning for primary and secondary PU/DTI prevention. Methods The study is employing a retrospective electronic health record (EHR) chart review of over 75 factors known to be relevant for pressure injury risk in individuals with a spinal cord injury (SCI) and routinely recorded in the EHR. We also perform tissue health assessments of a selected sub-group. A systems approach is being used to develop and validate the SCIPUD+ Resource incorporating the many risk factor domains associated with PU/DTI primary and secondary prevention, ranging from the individual’s environment to local tissue health. Our multiscale approach will leverage the strength of bioinformatics applied to an established national EHR system. A comprehensive model is being used to relate the primary outcome of interest (PU/DTI development) with over 75 PU/DTI risk factors using a retrospective chart review of 5000 individuals selected from the study cohort of more than 36,000 persons with SCI. A Spinal Cord Injury Pressure Ulcer and Deep Tissue Injury Ontology (SCIPUDO) is being developed to enable robust text-mining for data extraction from free-form notes. Results The results from this study are pending. Conclusions PU/DTI remains a highly significant source of morbidity for individuals with SCI. Personalized interactive care plans may decrease both initial PU formation and readmission rates for high-risk individuals. The project is using established EHR data to build a comprehensive, structured model of environmental, social and clinical pressure injury risk factors. The comprehensive SCIPUD+ health care tool will be used to relate the primary outcome of interest (pressure injury development) with covariates including environmental, social, clinical, personal and tissue health profiles as well as possible interactions among some of these covariates. The study will result in a validated tool for personalized implementation of CPG recommendations and has great potential to change the standard of care for PrI clinical practice by enabling clinicians to provide personalized application of CPG priorities tailored to the needs of each at-risk individual with SCI. Registered Report Identifier RR1-10.2196/10871
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Affiliation(s)
- Kath M Bogie
- Louis Stokes Cleveland VA Medical Center, Cleveland, OH, United States.,Department of Orthopaedics, Case Western Reserve University, Cleveland, OH, United States
| | - Guo-Qiang Zhang
- Institute for Biomedical Informatics, University of Kentucky, Lexington, KY, United States.,Department of Computer Science, University of Kentucky, Lexington, KY, United States
| | - Steven K Roggenkamp
- Institute for Biomedical Informatics, University of Kentucky, Lexington, KY, United States.,Department of Computer Science, University of Kentucky, Lexington, KY, United States
| | - Ningzhou Zeng
- Institute for Biomedical Informatics, University of Kentucky, Lexington, KY, United States.,Department of Computer Science, University of Kentucky, Lexington, KY, United States
| | - Jacinta Seton
- Louis Stokes Cleveland VA Medical Center, Cleveland, OH, United States
| | - Shiqiang Tao
- Institute for Biomedical Informatics, University of Kentucky, Lexington, KY, United States.,Department of Computer Science, University of Kentucky, Lexington, KY, United States
| | - Arielle L Bloostein
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, United States
| | - Jiayang Sun
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, United States
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20
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Gélis A, Dupeyron A, Daures JP, Goossens D, Gault D, Pedelucq JP, Enjalbert M, Maupas E, Kennedy P, Fattal C. Validity and internal consistency of the French version of the revised Skin Management Needs Assessment Checklist in people with spinal cord injury. Spinal Cord 2018; 56:1069-1075. [DOI: 10.1038/s41393-018-0156-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 04/06/2018] [Accepted: 04/16/2018] [Indexed: 12/31/2022]
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21
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Le Fort M, Espagnacq M, Albert T, Lefèvre C, Perrouin-Verbe B, Ravaud JF. Risk of pressure ulcers in tetraplegic people: a French survey crossing regional experience with a long-term follow-up. Eur J Public Health 2018; 28:993-999. [DOI: 10.1093/eurpub/cky084] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Marc Le Fort
- EHESP, High School of Public Health - MSSH, House of Social Sciences and Disability, Rennes Cedex, France
- Neurological Physical Medicine and Rehabilitation Department, University Hospital – Hôpital Saint-Jacques, Nantes Cedex 01, France
| | - Maude Espagnacq
- IRDES – Institute for Research and Documentation in Health Economics, Paris, France
| | | | - Chloë Lefèvre
- Neurological Physical Medicine and Rehabilitation Department, University Hospital – Hôpital Saint-Jacques, Nantes Cedex 01, France
| | - Brigitte Perrouin-Verbe
- Neurological Physical Medicine and Rehabilitation Department, University Hospital – Hôpital Saint-Jacques, Nantes Cedex 01, France
| | - Jean-François Ravaud
- EHESP, High School of Public Health - MSSH, House of Social Sciences and Disability, Rennes Cedex, France
- CERMES3, INSERM, CNRS, EHESS, Université Paris Descartes, Villejuif, France
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22
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Huang W, Zhu Y, Qu H. Use of an Alternating Inflatable Head Pad inPatients Undergoing Open Heart Surgery. Med Sci Monit 2018; 24:970-976. [PMID: 29451869 PMCID: PMC5824734 DOI: 10.12659/msm.906018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Preoperative symptoms like occipital pressure ulcers and alopecia areata (AA) significantly lowered patient quality of life. Therefore, preoperative nursing was in need of investigation. This study aimed to compare effects of an alternating inflatable head pad and a gel pad on occurrence of postoperative pressure ulcers and AA in patients undergoing open heart surgery. MATERIAL AND METHODS This was a prospective study. We allocated randomly 120 patients undergoing surgery (3-7 h) in the Yantai Yuhuangding Hospital affiliated to Qingdao University, China from January to October 2015 to the control (gel head pad) or the experimental (alternating inflatable head pad) group (n=60 per group). The incidence and severity of occipital pressure ulcer were graded by the classification system of the European Pressure Ulcer Advisory Panel (EPUAP). The degree of occipital alopecia was measured by hair pull test. This study used the t test and chi-square analysis. All statistics were analyzed by SPSS 21.0. RESULTS Compared with the control group, there was a significantly lower incidence and severity of occipital pressure ulcer and alopecia in the experimental group (9 cases/60 cases vs. 1 case/60 cases, P<0.01). Moreover, multivariate analysis showed the risk of developing occipital pressure ulcer after surgery was also obviously lower in the experimental group (OR 1.449-120.798; P<0.005). Hair pull test revealed that fewer patients in the experimental group had a hair loss over 10%. CONCLUSIONS The alternating inflatable head pad was effective in reducing the incidence and severity of occipital pressure ulcer and alopecia associated with surgery, which benefited the postoperative nursing and improved patient quality of life.
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Affiliation(s)
- Weijian Huang
- Eastern Operating Room, Yantai Yuhuangding Hospital, Yantai, Shandong, China (mainland)
| | - Yongjian Zhu
- Department of Nursing, Yantai Yuhuangding Hospital, Yantai, Shandong, China (mainland)
| | - Hua Qu
- Department of Nursing, Yantai Yuhuangding Hospital, Yantai, Shandong, China (mainland)
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Sonenblum SE, Sprigle SH. Buttock tissue response to loading in men with spinal cord injury. PLoS One 2018; 13:e0191868. [PMID: 29415014 PMCID: PMC5802854 DOI: 10.1371/journal.pone.0191868] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 01/13/2018] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE/BACKGROUND Despite the fact that most people with a spinal cord injury who use a wheelchair for mobility are considered at-risk for pressure ulcer (PrU) development, there still exists a spectrum of risk amongst this group. Efforts to differentiate risk level would benefit from clinical tools that can measure or predict the buttocks response to loading. Therefore, the goal of this study was to identify how tissue compliance and blood flow were impacted by clinically-measurable risk factors in young men with SCI. METHODS Blood flow at the ischial tuberosity was measured using laser Doppler flowmetry while the seated buttock was unloaded, and loaded at lower (40-60 mmHg) and high (>200 mmHg) loads. Tissue compliance of the buttock was measured using the Myotonometer while subject were lifted in a Guldmann Net. RESULTS Across 28 participants, blood flow was significantly reduced at high loads, while no consistent, significant changes were found at lower loads. At 40-60 mmHg, blood flow decreased in participants with a pressure ulcer history and lower BMI, but stayed the same or increased in most other participants. The buttock displaced an average of 9.3 mm (2.7 mm) at 4.2 N, which represented 82% (7%) of maximum displacement. BMI was related to the amount of buttock tissue displacement while smoking status explained some of the variation in the percent of max displacement. CONCLUSION Wide variability in tissue compliance and blood flow responses across a relatively homogeneous population indicate that differences in biomechanical risk may provide an explanation for the spectrum of PrU risk among persons with SCI.
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Affiliation(s)
- Sharon Eve Sonenblum
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, Georgia, United States of America
| | - Stephen H. Sprigle
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, Georgia, United States of America
- School of Industrial Design, Georgia Institute of Technology, Atlanta, Georgia, United States of America
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Martin ET, Haider S, Palleschi M, Eagle S, Crisostomo DV, Haddox P, Harmon L, Mazur R, Moshos J, Marchaim D, Kaye KS. Bathing hospitalized dependent patients with prepackaged disposable washcloths instead of traditional bath basins: A case-crossover study. Am J Infect Control 2017; 45:990-994. [PMID: 28502637 DOI: 10.1016/j.ajic.2017.03.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 03/20/2017] [Accepted: 03/20/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Basins used for patient bathing have been shown to be contaminated with multidrug-resistant organisms (MDROs) and have prompted the evaluation of alternatives to soap and water bathing methods. METHODS We conducted a prospective, randomized, open-label interventional crossover study to assess the impact of replacing traditional bath basins with prepackaged washcloths on the incidence of hospital-associated infections (HAIs), MDROs, and secondarily, rates of skin deterioration. Unit-wide use of disposable washcloths over an 8-month period was compared with an 8-month period of standard care using basins. RESULTS A total of 2,637 patients were included from 2 medical-surgical units at a single tertiary medical center, contributing 16,034 patient days. During the study period, there were a total of 33 unit-acquired infections, the rates of which were not statistically different between study phases (incidence rate ratio, 1.05; 95% confidence interval [CI], 0.50-2.23; P = .88). However, occurrence of skin integrity deterioration was significantly less in the intervention group (odds ratio, 0.44; 95% CI, 0.22-0.88; P = .02). CONCLUSIONS Although we were unable to demonstrate a significant reduction in HAI or MDRO acquisition, we found a decrease in skin deterioration with the use of disposable washcloths and confirmed earlier findings of MDRO contamination of wash basins.
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Krishnan S, Brick RS, Karg PE, Tzen YT, Garber SL, Sowa GA, Brienza DM. Predictive validity of the Spinal Cord Injury Pressure Ulcer Scale (SCIPUS) in acute care and inpatient rehabilitation in individuals with traumatic spinal cord injury. NeuroRehabilitation 2017; 38:401-9. [PMID: 27061168 DOI: 10.3233/nre-161331] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate the validity of the Spinal Cord Injury Pressure Ulcer Scale (SCIPUS) during acute care and inpatient rehabilitation following spinal cord injury (SCI) by determining critical cutoff points and assessing the ability to predict risk for pressure ulceration (PrU). DESIGN Retrospective. METHODS Sensitivity, specificity, and area under the curve (AUC) for the receiver operating characteristic were determined for the scale's ability to predict PrU 2-3 and 5-7 days after administrating the SCIPUS during acute care, and 5-7 and 14-21 days after administrating the SCIPUS during inpatient rehabilitation. RESULTS During acute hospitalization, SCIPUS's ability to assess risk for PrUs within 2-3 days was determined at cutoff score of 15 with 100% sensitivity and 75% specificity, AUC = 0.85. The scale was unable to assess PrU risk at 5-7 days, AUC < 0.6 at cutoff score of 13. During inpatient rehabilitation, the scale was unable to assess PrU risk at 5-7 and 14-21 days, AUC < 0.6 at cutoff score of 9. CONCLUSIONS The SCIPUS could predict PrU occurring within 2-3 days following administration during acute, but unable to predict over a longer term within acute or inpatient rehabilitation. Improved PrU risk assessment following SCI may be possible with modification to the SCIPUS.
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Affiliation(s)
- Shilpa Krishnan
- Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX, USA
| | - Rachelle S Brick
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Patricia E Karg
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Yi-Ting Tzen
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL, USA
| | - Susan L Garber
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Baylor, CA, USA
| | - Gwendolyn A Sowa
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
| | - David M Brienza
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
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Luther SL, Thomason SS, Sabharwal S, Finch DK, McCart J, Toyinbo P, Bouayad L, Matheny ME, Gobbel GT, Powell-Cope G. Leveraging Electronic Health Care Record Information to Measure Pressure Ulcer Risk in Veterans With Spinal Cord Injury: A Longitudinal Study Protocol. JMIR Res Protoc 2017; 6:e3. [PMID: 28104580 PMCID: PMC5290296 DOI: 10.2196/resprot.5948] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 09/09/2016] [Accepted: 10/30/2016] [Indexed: 12/05/2022] Open
Abstract
Background Pressure ulcers (PrUs) are a frequent, serious, and costly complication for veterans with spinal cord injury (SCI). The health care team should periodically identify PrU risk, although there is no tool in the literature that has been found to be reliable, valid, and sensitive enough to assess risk in this vulnerable population. Objective The immediate goal is to develop a risk assessment model that validly estimates the probability of developing a PrU. The long-term goal is to assist veterans with SCI and their providers in preventing PrUs through an automated system of risk assessment integrated into the veteran’s electronic health record (EHR). Methods This 5-year longitudinal, retrospective, cohort study targets 12,344 veterans with SCI who were cared for in the Veterans Health Administration (VHA) in fiscal year (FY) 2009 and had no record of a PrU in the prior 12 months. Potential risk factors identified in the literature were reviewed by an expert panel that prioritized factors and determined if these were found in structured data or unstructured form in narrative clinical notes for FY 2009-2013. These data are from the VHA enterprise Corporate Data Warehouse that is derived from the EHR structured (ie, coded in database/table) or narrative (ie, text in clinical notes) data for FY 2009-2013. Results This study is ongoing and final results are expected in 2017. Thus far, the expert panel reviewed the initial list of risk factors extracted from the literature; the panel recommended additions and omissions and provided insights about the format in which the documentation of the risk factors might exist in the EHR. This list was then iteratively refined through review and discussed with individual experts in the field. The cohort for the study was then identified, and all structured, unstructured, and semistructured data were extracted. Annotation schemas were developed, samples of documents were extracted, and annotations are ongoing. Operational definitions of structured data elements have been created and steps to create an analytic dataset are underway. Conclusions To our knowledge, this is the largest cohort employed to identify PrU risk factors in the United States. It also represents the first time natural language processing and statistical text mining will be used to expand the number of variables available for analysis. A major strength of this quantitative study is that all VHA SCI centers were included in the analysis, reducing potential for selection bias and providing increased power for complex statistical analyses. This longitudinal study will eventually result in a risk prediction tool to assess PrU risk that is reliable and valid, and that is sensitive to this vulnerable population.
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Affiliation(s)
- Stephen L Luther
- Center of Innovation on Disability and Rehabilitation Research, Health Services Research and Development, Department of Veterans Affairs, Tampa, FL, United States.,College of Public Health, University of South Florida, Tampa, FL, United States
| | - Susan S Thomason
- Center of Innovation on Disability and Rehabilitation Research, Health Services Research and Development, Department of Veterans Affairs, Tampa, FL, United States.,Tampa VA Research and Education Foundation, Inc, Tampa, FL, United States
| | - Sunil Sabharwal
- VA Boston Healthcare System, VA New England Healthcare System, Department of Veterans Affairs, West Roxbury, MA, United States
| | - Dezon K Finch
- Center of Innovation on Disability and Rehabilitation Research, Health Services Research and Development, Department of Veterans Affairs, Tampa, FL, United States
| | - James McCart
- Center of Innovation on Disability and Rehabilitation Research, Health Services Research and Development, Department of Veterans Affairs, Tampa, FL, United States.,Muma College of Business, University of South Florida, Tampa, FL, United States
| | - Peter Toyinbo
- Center of Innovation on Disability and Rehabilitation Research, Health Services Research and Development, Department of Veterans Affairs, Tampa, FL, United States
| | - Lina Bouayad
- Center of Innovation on Disability and Rehabilitation Research, Health Services Research and Development, Department of Veterans Affairs, Tampa, FL, United States
| | - Michael E Matheny
- Geriatrics Research Education and Clinical Care, Tennessee Valley Healthcare System, Department of Veterans Affairs, Nashville, TN, United States.,Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States.,Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States.,Division of General Internal Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Glenn T Gobbel
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States.,Research and Development Service, Tennessee Valley Healthcare System, Department of Veterans Affairs, Nashville, TN, United States
| | - Gail Powell-Cope
- Center of Innovation on Disability and Rehabilitation Research, Health Services Research and Development, Department of Veterans Affairs, Tampa, FL, United States.,College of Public Health, University of South Florida, Tampa, FL, United States.,College of Nursing, University of South Florida, Tampa, FL, United States
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Tung JY, Stead B, Mann W, Ba'Pham, Popovic MR. Assistive technologies for self-managed pressure ulcer prevention in spinal cord injury: a scoping review. ACTA ACUST UNITED AC 2016; 52:131-46. [PMID: 26237111 DOI: 10.1682/jrrd.2014.02.0064] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 01/26/2015] [Indexed: 11/05/2022]
Abstract
Pressure ulcers (PUs) in individuals with spinal cord injury (SCI) present a persistent and costly problem. Continuing effort in developing new technologies that support self-managed care is an important prevention strategy. Specifically, the aims of this scoping review are to review the key concepts and factors related to self-managed prevention of PUs in individuals with SCI and appraise the technologies available to assist patients in self-management of PU prevention practices. There is broad consensus that sustaining long-term adherence to prevention regimens is a major concern. Recent literature highlights the interactions between behavioral and physiological risk factors. We identify four technology categories that support self-management: computer-based educational technologies demonstrated improved short-term gains in knowledge (2 studies), interface pressure mapping technologies demonstrated improved adherence to pressure-relief schedules up to 3 mo (5 studies), electrical stimulation confirmed improvements in tissue tolerance after 8 wk of training (3 studies), and telemedicine programs demonstrated improvements in independence and reduced hospital visits over 6 mo (2 studies). Overall, self-management technologies demonstrated low-to-moderate effectiveness in addressing a subset of risk factors. However, the effectiveness of technologies in preventing PUs is limited due to a lack of incidence reporting. In light of the key findings, we recommend developing integrated technologies that address multiple risk factors.
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Affiliation(s)
- James Y Tung
- Department of Mechanical and Mechatronics Engineering, University of Waterloo, Waterloo, Canada
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Sonenblum SE, Sprigle SH, Martin JS. Everyday sitting behavior of full-time wheelchair users. ACTA ACUST UNITED AC 2016; 53:585-598. [DOI: 10.1682/jrrd.2015.07.0130] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 10/02/2015] [Indexed: 11/05/2022]
Affiliation(s)
- Sharon E. Sonenblum
- Rehabilitation Engineering and Applied Research Laboratory, Georgia Institute of Technology, Atlanta, GA
| | - Stephen H. Sprigle
- Rehabilitation Engineering and Applied Research Laboratory, Georgia Institute of Technology, Atlanta, GA
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Psychometric Properties of the Spinal Cord Injury Pressure Ulcer Scale (SCIPUS) for Pressure Ulcer Risk Assessment During Inpatient Rehabilitation. Arch Phys Med Rehabil 2015. [DOI: 10.1016/j.apmr.2015.06.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Lifestyle risk factors for pressure ulcers in community-based patients with spinal cord injuries in Japan. Spinal Cord 2015; 53:476-81. [PMID: 25665536 DOI: 10.1038/sc.2015.18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 12/19/2014] [Accepted: 01/08/2015] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Case-control study. OBJECTIVES To identify daily living-related risk factors for pressure ulcer (PU) occurrence in community-living patients with spinal cord injury (SCI). To determine whether seat pressure influences PU occurrence, and how often patients with SCI perform pressure relief activities while living in the community. SETTING Kanagawa Rehabilitation Hospital, Kanagawa, Japan. METHODS Thirty-one patients admitted to this hospital for PU treatment were included in the case (PU) group. Thirty outpatients who did not have PUs at the time of the study, and had lived without PUs for at least a year, were included in the control (No PU) group. Patients were interviewed about lifestyle-related PU risk factors and a pressure-mapping system was used to measure interface pressure (IP) on their wheelchair seat. The No PU group patients recorded their daily activities and pressure relief maneuvers for 1 week. RESULTS Eight lifestyle factors and one risk assessment scale significantly differed between groups. Three factors showed significant odds ratios by logistic regression. IP did not significantly differ between groups. The self-counted number of pressure relief maneuvers (median (25th-75th percentile)) performed per hour in the No PU group was 2.5 (0.7-4.3) and including transfer and urination was 3.5 (2.0-5.3). CONCLUSION We identified potential PU risk factors related to lifestyle. The scores of one risk assessment scale were also associated with PU risk. Our results did not suggest an IP damage threshold. Patients in the No PU group performed pressure relief maneuvers, including related activities, approximately once every 17 min.
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Gould LJ, Olney CM, Nichols JS, Block AR, Simon RM, Guihan M. Spinal Cord Injury survey to determine pressure ulcer vulnerability in the outpatient population. Med Hypotheses 2014; 83:552-8. [PMID: 25241921 DOI: 10.1016/j.mehy.2014.08.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 08/14/2014] [Accepted: 08/24/2014] [Indexed: 10/24/2022]
Abstract
Pressure ulcers are one of the most common causes of morbidity, mortality and rehospitalization for those living with Spinal Cord Injury (SCI). Literature examining risk and recurrence of pressure ulcers (PrUs) has primarily focused on the nursing home elderly who do not have SCI. More than 200 factors that increase PrU risk have been identified. Yet unlike the elderly who incur pressure ulcers in nursing homes or when hospitalized, most persons with SCI develop their pressure ulcers as outpatients, while residing in the community. The Veterans Health Administration (VHA) provides medical care for a large number of persons with chronic SCI. Included in the VHA SCI model of chronic disease management is the provision of an annual Comprehensive Preventive Health Evaluation, a tool that has potential to identify individuals at high risk for PrUs. This research was motivated by the clinical observation that some individuals appear to be protected from developing PrUs despite apparently 'risky' behaviors while others develop PrUs despite vigilant use of the currently known preventative measures. There is limited literature regarding protective factors and specific risk factors that reduce PrU occurrence in the community dwelling person with chronic SCI have not been delineated. The purpose of this study is to examine the preliminary hypothesis that there are biological and/or psychosocial factors that increase or reduce vulnerability to PrUs among persons with SCI. A limited number of refined hypotheses will be generated for testing in a prospective fashion. A retrospective cross-sectional survey of 119 randomly selected Veterans with SCI undergoing the Comprehensive Health Prevention Evaluation during the year 2009 was performed. Factors that differed between patients with 0, 1 or ⩾2 PrUs were identified and stratified, with an emphasis on modifiable risk factors. Three hypotheses generated from this study warrant further investigation: (1) cumulative smoking history increases the risk of PrUs independent of co-morbidities, (2) being moderately overweight, BMI>25, with or without spasticity, is a modifiable factor that may be protective and (3) increased use of a caregiver does not reduce PrU risk. Prospective studies that focus on these hypotheses will lead to evidence-based risk assessment tools and customized interventions to prevent PrUs in persons with SCI in the outpatient setting.
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Affiliation(s)
- Lisa J Gould
- James A Haley Veterans Hospital, 13000 Bruce B. Downs Blvd, Tampa, FL 33612, United States.
| | - Christine M Olney
- James A Haley Veterans Hospital, 13000 Bruce B. Downs Blvd, Tampa, FL 33612, United States
| | - Jane S Nichols
- James A Haley Veterans Hospital, 13000 Bruce B. Downs Blvd, Tampa, FL 33612, United States
| | - Aaron R Block
- James A Haley Veterans Hospital, 13000 Bruce B. Downs Blvd, Tampa, FL 33612, United States
| | - Ross M Simon
- James A Haley Veterans Hospital, 13000 Bruce B. Downs Blvd, Tampa, FL 33612, United States
| | - Marylou Guihan
- James A Haley Veterans Hospital, 13000 Bruce B. Downs Blvd, Tampa, FL 33612, United States
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As of 2012, what are the key predictive risk factors for pressure ulcers? Developing French guidelines for clinical practice. Ann Phys Rehabil Med 2012; 55:454-65. [DOI: 10.1016/j.rehab.2012.08.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2012] [Accepted: 08/07/2012] [Indexed: 11/24/2022]
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Bogie K, Powell HL, Ho CH. New concepts in the prevention of pressure sores. HANDBOOK OF CLINICAL NEUROLOGY 2012; 109:235-246. [PMID: 23098716 DOI: 10.1016/b978-0-444-52137-8.00014-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Pressure sores are a serious, and costly, complication for many patients with reduced mobility and sensation. Some populations, such as those with spinal cord injury (SCI), remain at high risk throughout their lifetime. Prevention is highly preferable and while the concept is readily definable, it is much more challenging to develop valid preventative measures. Subjective and objective approaches to risk factor assessment before pressure sores develop are reviewed, including risk status scales and emerging techniques to assess deep tissue injury. Devices to prevent pressure sores have traditionally focused on pressure-relieving cushions and mattresses. Technological advances being applied in the development of new pressure sore prevention devices are presented. Clinical evidence-based practice is integral to pressure sore prevention. Comprehensive assessment must include evaluation of systemic diseases, anatomical and physiological factors, together with environmental and psychosocial factors, which can all contribute to pressure sore development. Extrinsic factors need to be considered in conjunction with intrinsic tissue health factors and are reviewed together with an evaluation of currently available clinical practice guidelines. This chapter presents the broad diversity of factors associated with pressure sore development and highlights the need for an interdisciplinary team approach in order to maximize successful prevention of pressure sores.
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Affiliation(s)
- Kath Bogie
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, USA.
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Iranmanesh S, Rafiei H, Sabzevari S. Relationship between Braden scale score and pressure ulcer development in patients admitted in trauma intensive care unit. Int Wound J 2011; 9:248-52. [PMID: 21910830 DOI: 10.1111/j.1742-481x.2011.00852.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The purpose of this study was to determine the relationship between the scores of Braden scale and pressure ulcer development among critically ill patients. All patients who admitted to intensive care unit (ICU) in 3 months (during July-October 2010) were surveyed with Braden scale. Patients who gained higher score of Braden scale were at lower risk for pressure ulcer development compared with the other patients. Braden scale is a useful tool for predicting pressure ulcer development in trauma ICU patients. Also, factors such as age and level of consciousness may influence pressure ulcer development.
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Affiliation(s)
- Sedigheh Iranmanesh
- Razi Faculty of Nursing and Midwifery, Kerman Medical University, Kerman, Iran
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Comparing and contrasting knowledge of pressure ulcer assessment, prevention and management in people with spinal cord injury among nursing staff working in two metropolitan spinal units and rehabilitation medicine training specialists in a three-way comparison. Spinal Cord 2011; 50:159-64. [DOI: 10.1038/sc.2011.88] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Sarasúa JG, López SP, Viejo MÁ, Basterrechea MP, Rodríguez AF, Gutiérrez AF, Gala JG, Menéndez YM, Augusto DE, Arias AP, Hernández JO. Treatment of pressure ulcers with autologous bone marrow nuclear cells in patients with spinal cord injury. J Spinal Cord Med 2011; 34:301-7. [PMID: 21756569 PMCID: PMC3127373 DOI: 10.1179/2045772311y.0000000010] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
CONTEXT Pressure ulcers are especially difficult to treat in patients with spinal cord injury (SCI) and recurrence rates are high. Prompted by encouraging results obtained using bone marrow stem cells to treat several diseases including chronic wounds, this study examines the use of autologous stem cells from bone marrow to promote the healing of pressure ulcers in patients with SCI. OBJECTIVE To obtain preliminary data on the use of bone marrow mononuclear cells (BM-MNCs) to treat pressure ulcers in terms of clinical outcome, procedure safety, and treatment time. PARTICIPANTS Twenty-two patients with SCI (19 men, 3 women; mean age 56.41 years) with single type IV pressure ulcers of more than 4 months duration. INTERVENTIONS By minimally invasive surgery, the ulcers were debrided and treated with BM-MNCs obtained by Ficoll density gradient separation of autologous bone marrow aspirates drawn from the iliac crest. RESULTS In 19 patients (86.36%), the pressure ulcers treated with BM-MNCs had fully healed after a mean time of 21 days. The number of MNCs isolated was patient dependent, although similar clinical outcomes were observed in each case. Compared to conventional surgical treatment, mean intra-hospital stay was reduced from 85.16 to 43.06 days. Following treatment, 5 minutes of daily wound care was required per patient compared to 20 minutes for conventional surgery. During a mean follow-up of 19 months, none of the resolved ulcers recurred. CONCLUSIONS Our data indicate that cell therapy using autologous BM-MNCs could be an option to treat type IV pressure ulcers in patients with SCI, avoiding major surgical intervention.
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Affiliation(s)
- J González Sarasúa
- Servicio de Cirugía Plástica, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - S Pérez López
- Unidad de Coordinación de Trasplantes y Terapia Celular, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - M Álvarez Viejo
- Unidad de Coordinación de Trasplantes y Terapia Celular, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - M Pérez Basterrechea
- Unidad de Coordinación de Trasplantes y Terapia Celular, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - A Ferrero Gutiérrez
- Unidad de Coordinación de Trasplantes y Terapia Celular, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - J García Gala
- Servicio de Transfusión, Servicio de Hematología y Hemoterapia, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Y Menéndez Menéndez
- Unidad de Coordinación de Trasplantes y Terapia Celular, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - D Escudero Augusto
- Unidad de Coordinación de Trasplantes y Terapia Celular, Hospital Universitario Central de Asturias, Oviedo, Spain
- Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - A Pérez Arias
- Servicio de Cirugía Plástica, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - J Otero Hernández
- Unidad de Coordinación de Trasplantes y Terapia Celular, Hospital Universitario Central de Asturias, Oviedo, Spain
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Kottner J, Balzer K. Do pressure ulcer risk assessment scales improve clinical practice? J Multidiscip Healthc 2010; 3:103-11. [PMID: 21197359 PMCID: PMC3004596 DOI: 10.2147/jmdh.s9286] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2010] [Indexed: 11/23/2022] Open
Abstract
Standardized assessment instruments are deemed important for estimating pressure ulcer risk. Today, more than 40 so-called pressure ulcer risk assessment scales are available but still there is an ongoing debate about their usefulness. From a measurement point of view pressure ulcer (PU) risk assessment scales have serious limitations. Empirical evidence supporting the validity of PU risk assessment scale scores is weak and obtained scores contain varying amounts of measurement error. The concept of pressure ulcer risk is strongly related to the general health status and severity of illness. A clinical impact due do the application of these scales could also not be demonstrated. It is questionable whether completion of standardized pressure ulcer risk scales in clinical practice is really needed.
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Affiliation(s)
- Jan Kottner
- Department of Nursing Science, Charité-Universitätsmedizin Berlin, Germany
| | - Katrin Balzer
- Nursing Research Group, Institute for Social Medicine, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
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Occurrence and predictors of pressure ulcers during primary in-patient spinal cord injury rehabilitation. Spinal Cord 2010; 49:106-12. [DOI: 10.1038/sc.2010.66] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Wai A, Foo S, Huang W, Biswas J, Hsia CC, Liou K, Yap P. Lying Posture Classification for Pressure Ulcer Prevention. JOURNAL OF HEALTHCARE ENGINEERING 2010. [DOI: 10.1260/2040-2295.1.2.217] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Neufeld S, Lysack C. The 'risk inventory for persons with spinal cord injury': development and preliminary validation of a risk assessment tool for spinal cord injury. Disabil Rehabil 2009; 32:230-8. [PMID: 20001829 DOI: 10.3109/09638280903095957] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To present a new short instrument to measure perceived risks of common everyday activities engaged in by persons with spinal cord injury (SCI), and to provide preliminary data on its psychometric properties. METHOD Community-dwelling men and women with SCI (N = 139) in metropolitan Detroit completed the risk inventory for persons with spinal cord injury (RISCI). They also answered a risk-taking identity question ('Are you a risk-taker'?) and completed the risk orientation questionnaire (ROQ) (Rohrmann, http://www.rohrmannresearch.net/ , 2008), a risk propensity measure. RESULTS All items of the RISCI correlated positively with each other and the total score; internal reliability as measured by Cronbach's alpha was 0.86. Principal components factor analysis confirmed a one-factor structure which explained 41% of the variance. A three-factor solution with readily interpretable factors explained 64% of the variance. Content validity was established through extensive consultations with persons with SCI in the development of the measure. Discriminant validity was supported by the ability of the RISCI to distinguish between subsamples (for example, between men and women, those with paraplegia and tetraplegia) for whom differences in risk assessment might be expected. Criterion validity was supported by significant relationships in the expected directions between the RISCI and risk-taking identity and between the RISCI and the ROQ. CONCLUSIONS Findings suggest that the RISCI is a brief, easy to administer and psychometrically sound measure of perceived risk of activities common in daily life for use with persons with SCI.
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Affiliation(s)
- Stewart Neufeld
- Institute of Gerontology, Wayne State University, Detroit 48202, Michigan, USA.
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Gélis A, Dupeyron A, Legros P, Benaïm C, Pelissier J, Fattal C. Pressure ulcer risk factors in persons with SCI: Part I: Acute and rehabilitation stages. Spinal Cord 2008; 47:99-107. [PMID: 18762807 DOI: 10.1038/sc.2008.107] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Pressure ulcers (PUs) are a common complication following a spinal-cord injury (SCI). Good prevention requires identifying the individuals at risk for developing PUs. Risk assessment scales used nowadays were designed on pathophysiological concepts and are not SCI-specific. Recently, an epidemiological approach to PU risk factors has been proposed to design an SCI-specific assessment tool. The first results seem quite disappointing, probably because of the level of evidence of the risk factors used. OBJECTIVE To determine PU risk factors correlated to the patients with SCI, medical care management during the acute as well as in the rehabilitation and chronic stages. This first part focuses on identifying the risk factors during the acute and rehabilitation stages. MATERIALS AND METHODS Systematic review of the literature. RESULTS Six studies met our inclusion criteria. The risk factors during the acute stage of an SCI are essentially linked to care management and treatment modalities. There is insufficient evidence to make a recommendation on medical risk factors, except for low blood pressure on admission to the Emergency Room, with a moderate level of evidence. Regarding the rehabilitation stage, no study was deemed relevant. DISCUSSION AND CONCLUSIONS Additional observational studies are needed, for both the acute and rehabilitation stages, to improve this level of evidence. However, this systematic review unveiled the need for a carefully assessed t care management and the related practices, especially during the acute stage of an SCI.
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Affiliation(s)
- A Gélis
- Département de Médecine Physique et de Réadaptation, Centre Hospitalo-Universitaire Caremeau, Nîmes, France.
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Abstract
PURPOSE OF REVIEW To review recent work on pressure ulcer prevention and treatment in the intensive care unit within the context of previous work. RECENT FINDINGS Although pressure ulcerations are an age-old and relatively common problem, their pathophysiology, risk factors for their development, and treatment options lack complete understanding. Most of the available literature is based on noncritical care patient clinical experience in noncritical care journals. Previous estimates of pressure ulcer underestimate the problem in high-acuity intensive care units. Available risk factors in previously validated tools may not be accurate in the intensive care unit patient population. However, the current literature provides an initial footing for intensivists to improve their pressure ulcer prevention and treatment methods that will become increasingly important for clinical certification as well as research. SUMMARY Preventing and treating pressure ulcers will continue to be a troublesome problem for intensivists. Accurate assessments and comparisons remain problematic across a heterogeneous intensive care unit population. Risk stratification schema need tailoring to the problems of intensive care unit patients. Treatment modalities may not prevent all pressure ulcer development or extension. Available data support dedicated training of nurses and physicians to maximize local intensive care unit resources to minimize the impact of pressure ulceration.
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